Wellness/Vaccination Appointment Check- in Questions:

Email to: northsideanimalhospital@tds.net as soon as possible before your appointment. Thank you.
Name ______________________________ Pet’s Name________________________
1) Are there any changes in your address, phone number(s) or e-mail address?
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2) Phone number to reach you today?
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3) What diet is your pet eating? How much is fed per day?
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4) Is your pet getting treats or table food? If so, what kind and how much?
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5) Is your pet on heartworm preventative? What kind? Year round or seasonal?
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6) Do you need heartworm preventative today? If so, how many?
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7) Is your pet on Flea and Tick preventative? What kind? Year round or seasonal?
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8) Do you need Flea and Tick preventative today? If so, how many?
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9) Your pet will be updated for any vaccines due at this time. If you have questions regarding this,
please let us know.
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10) Has your pet ever had a reaction to a vaccination in the past (swelling, vomiting, severe
soreness, lethargy, difficulty breathing)? If so, do you recall what happened? Did they need
medical intervention?
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11) Does your pet go to a groomer or is your pet boarded?
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12) For cats, do they go outside sometimes or strictly indoors? For dogs, do they go to the
dog park? Day care? Camping/Hiking?
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13) How is your pet’s energy level? If it has changed, please explain how and how long this has
been occurring.
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14) *Has your pet been vomiting, having diarrhea, coughing or sneezing. If any of these are
occurring, please explain how long this has been going on.
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15) *Has there been any change in how much water your pet is drinking or changes in the amount
of urination?
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16) Do you brush your pet’s teeth or use any other dental hygiene products such as chews, tartar
control treats or water additives?
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17) Does your pet have any new lumps or bumps or ones that have changed? If so, please
indicate where, how long it has been there and if you authorize the lump to be aspirated and
cells evaluated under the microscope (cytology).
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18) Please list any medication or supplements your pet is taking.
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19) *Does your pet have any behavioral issue? If so please describe.
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20) *Is your pet limping or having trouble getting around? If so please describe.
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21) Do you want your pet’s nails trimmed today?
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22) Do you have any other special concerns for today?
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*Please note that some behavioral issues or medical issues such as limping, vomiting, weight loss
may require an additional appointment to fully evaluate as they can be beyond the scope of a
wellness exam.
Wellness Panel: Blood work based on the age of your pet is recommended yearly. The blood work
gives us a baseline of your pet’s overall health and allows us to monitor trends. The goal is to catch
changes as early as possible. Please let us know if you authorize this today or have questions about
the wellness panel. This includes the stool sample for both dogs and cats and the heartworm/tick test
for dogs.